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Latest Proposals for Reforming ACA

When the bill to replace the Affordable Care Act was withdrawn in March, the Trump administration focused their attention on other matters, like the upcoming budget for now. However in recent days vague suggestions have begun to emerge that the issue of the "repeal and replace Obamacare" is still lingering. Clearly people around the administration and congress are tinkering with new suggestions. Moreover, all of congress clearly want changes in the ACA to fix some evident problems with it.

The American Health Care Act (AHCA), which was cobbled together by congress in a hasty effort to satisfy the Trump campaign promise included these factors:

  • The bill would include the ability to buy health insurance across state lines (actually this provision was not in the first version of the act but was promised for later revisions).
  • The bill would provide advanceable tax credits for the cost of privately purchased health insurance, which would allow taxpayers to reduce their tax bill by the amount of the tax credit. The credit was to be between $2,000 and $4,000.
  • The bill would have allowed insurance companies to charge older enrollees more than younger ones.
  • Instead of the individual mandate of the ACA, the bill would impose a surcharge on anyone who let their insurance lapse
  • The bill would allow states to require Medicaid recipients to work in order to qualify.
  • The bill would have defunded Planned Parenthood for (at least) a year.
  • The bill would reduce federal spending on Medicaid by $880 billion over then years, scaling back the enhanced funding for expanded Medicaid adopted by 30 states.
  • The bill would place a cap on Medicaid spending on a per Medicaid enrollee basis. The cap would be indexed to the consumer price index for medical care. States would have to limit coverage or force Medicaid patients to cover more of their medical expense.

Noises coming from the House Republican caucus are suggesting that new approaches to a health care repeal and replace bill are somewhere in the minds of House Republican now. They are currently biding their time.

NBC News says that Vice President Pence was dispatched to the Capital late on March 3, 2017 armed with compromise proposals to re-waken the idea of an ACA replacement bill. The new compromise ideas were designed to jar support from the conservative House membership as well as moderate members who opposed the last bill. House Republicans only say, "we are still talking." The idea appears to be that some time in the near future, the House will produce a new health care replacement bill.

The compromises Pence brought to the House were that:

  • States would have the opportunity to obtain federal waivers so they don't have to impose ACA requirements. States would only have to show that getting rid of insurance regulations, such as essential health benefits and community health ratings, would lower the cost of premiums.
  • Under the proposals, states could opt out of the community health rating that puts limits on what insurance companies can charge older people at five times what they charge young, healthy people.
  • The compromise would not allow states to waive the essential health benefit requirements for dependents under 25.
  • The compromise would not allow states to opt out of the coverage for pre-existing conditions requirements.
  • The compromise would also not allow states to impose lifetime spending caps.
  • A new amendment providing for "high risk pools" would subsidize pricier insurance coverage for seriously ill people.

Moderate Republicans want more of the ACA to remain in place. Conservative Republicans have their own concerns about cuts the AHCA made to Medicaid.

Deadlines in congress are now tight since the House leaves on April 7 for a two-week Spring recess and they have to pass a funding bill before April 28. President Trump is hoping for progress on putting together another ACA replacement before the recess.